The second-largest Ebola outbreak ever continues to spread, and health officials now say it’s likely to reach the populous city of Goma. Once there, the risk of it spreading beyond the Democratic Republic of Congo to Rwanda, South Sudan, or Uganda increases.

Only a fraction of the health centres in Goma, the capital of North Kivu province, are prepared for a large-scale outbreak. The city, about 300 kilometres from the outbreak’s epicentre, sits at a major trade and migration crossroads and borders Rwanda, where Kigali’s international airport is only 160 kilometres away.

“I wouldn’t say (the spread to Goma) is inevitable, but it’s highly probable,” said Ray Arthur, director of the Global Disease Detection Operations Center at the US Centers for Disease Control and Prevention.

In the past three weeks, the number of areas with reported infections has increased from 21 to 22, with the newest affected area lying between Butembo – a city and trading hub near the epicentre – and Goma, said Arthur. Health zones where transmissions had previously stopped are now seeing new cases again.

If the disease reaches Goma, it will have far-reaching regional implications.

“There would be a whole set of political factors, a huge impact on the economy, and a huge social impact,” said Tariq Riebl, emergency response director for the International Rescue Committee, adding that there would be a domino effect regionally.

While cases in densely populated and well-connected Rwanda would drive up the risk of wider regional spread, South Sudan and Uganda both suffer from an acute lack of trained healthcare workers. The security situation in South Sudan, where sporadic clashes continue, would pose a major challenge, while none of the three neighbouring countries have enough equipped clinics to deal with a large-scale outbreak.

“The longer transmission goes on, the more likely it will get to one of those countries,” Arthur said.

If the WHO declares the outbreak a Public Health Emergency of International Concern, or PHEIC, that would likely lead to travel and trade restrictions – measures that could complicate humanitarian operations if border crossings are closed or suspended.

The WHO decided – for a second time – on 12 April not to declare the Ebola situation in Congo a PHEIC, but is under increasing pressure to do so from some public health experts. One concern if it does is that resulting border closures might increase the risk of transnational spread due to more people travelling illegally through porous borders.

With wider spread now looking likely, more staff from the US Centers for Disease Control and Prevention, Médecins Sans Frontières, UNICEF, and the World Health Organisation – as well as from other groups and NGOs – have been deployed to Goma.

There is currently no dedicated Ebola treatment centre in Goma, so isolating patients may be difficult. Hundreds of small clinics are scattered around the city across a large area, which would make it harder to monitor people if they became sick. There is also a shortage of trained nurses.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 21, 2019

The epidemiological situation of the Ebola Virus Disease dated May 20, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed.

• 292 suspected cases under investigation;

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka:

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Butembo and 1 in Musienene;

º 2 deaths at the CTE of Beni;

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa;

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019.

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

● In April, three new PoE screening sites were established and operationalized - Kerwa in Kajo-Keji county, Birigo in Lainya county, and Lasu in Yei county - which are all in Western Equatoria State. Currently, IOM is operating in 13 active PoE EVD screening sites.

● DTM interviewed 6,246 households comprising of 24,755 individuals who arrived in South Sudan from abroad along South Sudan’s southern border.

● The majority are South Sudanese nationals (79.2%) followed by Ugandan (13.6%) and DRC nationals (4.4%). Most incoming movement was due to economic reasons (26.8%), health-care (13.6%) and return after voluntary travel (11.4%). 10.5% of individuals intended to stay at their destination for more than three months.

● During this reporting period, WASH completed construction of the medical waste management system including incinerators and waste pits at Panyume Primary Health Care Center (PHCC).

● WASH also established 2 stances of temporary latrines and 4 mobile handwashing stands, and provided IPC trainings to casual workers (screeners, cleaners, health hygiene promotors etc.) at all the three new PoE screening sites in Kerwa, Birigo and Lasu which were constructed in April.

The next global pandemic is a matter of when, not if. Preparing for this inevitability requires that policy­makers understand not just the science of limiting dis­ease transmission or engineering a drug, but also the practical challenges of expanding a response strategy to a regional or global level. Achieving success at such scales is largely an issue of operational, strategic, and policy choices—areas of pandemic preparedness that remain underexplored.

The response to the 2014–2015 Ebola outbreak in West Africa illuminates these challenges and highlights steps toward better preparedness. Ebola was a known disease whose basic transmission pathways and con­trol strategies were understood. Yet traditional Ebola control strategies were premised on small, non-urban outbreaks, and they rapidly proved inadequate as the disease reached urban environments, forcing policy­makers to develop new strategies and operational plat­forms for containing the outbreak, which generated unique policy challenges and political pressures. Lack­ing a blueprint for controlling Ebola at scale, response leaders scrambled to catch up as the disease began threatening the wider West African region.

This report explores the lessons of the Ebola outbreak through the lens of the US and UN policymakers who were forced to construct an unprecedented response in real time. It tells the story of their choices around four major policy challenges:

1. Operationalizing the US government response

2. Balancing the politics and the science of travel restrictions

3. Defining the role of a reluctant military

4. Coordinating complex international partnerships

The report draws on interviews with 19 high-level US and UN policymakers, a desk review of after-action reports, and the author’s own experiences while lead­ing the response efforts of the US Agency for Interna­tional Development (USAID).

Kampala, 2nd May 2019: - Uganda’s Minister of Health Dr Jane Ruth Aceng has lauded international partners for supporting the Democratic Republic of Congo (DRC) battle the current Ebola Virus Disease (EVD) outbreak and the neighbouring countries in their preparedness and readiness phase.

“The outbreak in DRC affects everyone and while we have no confirmed cases in the neighbouring countries, preparation is paramount. I thank the partners for their support in both response and preparedness modes during this EVD outbreak,” she said.

Dr Aceng was closing the two-day International Partners meeting convened by the World Health Organization Regional Office for Africa (WHO-AFRO) that sought to strengthen partnerships for EVD preparedness and response.

While appreciating the various interventions that have been implemented to control the outbreak in DRC and prevent spread to other countries, Dr Aceng singled out vaccination of health workers, cross border collaboration and awareness creation as interventions that have helped Uganda and other countries stay EVD-free up to now.

“Vaccination has been a major breakthrough in the management of Ebola. Many lives have been saved and spread averted because of vaccination of frontline health workers and people in affected communities” she observed.

Dr Aceng reported the excellent collaboration between health workers in Uganda and DRC that has enabled the identification and follow-up of several people suspected to be EVD contacts. “The colleagues in DRC have alerted us several times about suspected contacts who we have followed and handled appropriately,” she said.

Awareness creation has also contributed tremendously to prevent the spread of EVD within DRC and to other countries. “Awareness creation should continue in all communities so that out people remain alert,” said Dr Aceng.

However, Dr Aceng also proposed two issues which she strongly urged international partners to always adhere to in order to ensure effective and sustainable response not only to EVD but also other disease outbreaks in Africa.

“First always ensure transparency and accountability in all actions and in what you do on the ground. Share what you are doing based on the funds given because it not only helps to avoid duplication of work but also builds donor and community confidence,” she said adding that this will contribute to building strong and resilient health systems in Africa.

"Secondly, I urge you to always ensure country leadership and ownership in your work. Let country authorities be in charge of and lead preparedness and response activities because they know the countries better than you. Please don’t impose, instead, work with us and support us within the national government structures” she said.

The epidemiological situation of the Ebola Virus Disease dated 29 April 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,480, of which 1,414 are confirmed and 66 are probable. In total, there were 970 deaths (904 confirmed and 66 probable) and 412 people cured.

• 279 suspected cases under investigation;

• 14 new confirmed cases, including 6 in Katwa, 2 in Musienene, 2 in Butembo, 1 in Mabalako, 1 in Beni, 1 in Kayna and 1 in Kalunguta;

• 13 new confirmed case deaths, including

º 6 community / hospital deaths, 2 in Katwa, 2 in Musienene, 1 in Kayna and 1 in Beni;

º 7 CTE / CT deaths, including 4 in Butembo and 3 in Katwa;

• 1 new healed from the CTE of Butembo.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response

Establishment of multisectoral Ebola Response Committee

• Considering the persistence of the Ebola epidemic in the provinces of North Kivu and Ituri and on the instructions of the President of the Republic at the meeting of 27 April 2019, Prime Minister Bruno Tshibala Nzenzhe and the Minister of Health, Dr. Oly Ilunga Kalenga, signed on Tuesday, April 30, 2019, the decree establishing, organizing and operating the multisectoral committee for the response of the Ebola virus disease in the Democratic Republic of Congo.

• This Committee's mission is to:

1. Oversee the multi-sectoral response to the current Ebola virus disease in the provinces of North Kivu and Ituri;

2. Formulate the necessary measures to be taken at government level;

3. Collaborate with institutions at central, provincial and decentralized territorial entities to prevent the spread of the epidemic;

4. Propose the allocation of resources needed for the response to end the epidemic;

5. Ensure an optimal link between the overall response strategy and sectoral policies.

• The Committee meets once a week and whenever necessary, when convened by its Coordinator. He reports to the President of the Republic, once a week, and keeps him fully informed of the work, interventions and evolution of the epidemic.

• The Committee is composed of the Prime Minister, who is the Coordinator, the Deputy Prime Minister, Minister of the Interior and Security, the Minister of the Budget, the Minister of Defense, the Minister of Finance, the Minister of Health who is the Secretary of the Committee, the Minister of Communication and Media, the Minister of Humanitarian Action and National Solidarity, the Minister of Social Affairs, and a representative of the Cabinet of the President of the Republic. Each member of the Committee is responsible for the response in their area of ​​activity.

• Each member of the Committee invites the experts and partners in the work of his sector of activity whenever necessary. These experts and partners will be able to integrate the technical commissions and take part in the work of each sector of activity.

• As a reminder, for the health pillar of the Ebola response, the Ministry of Health has created nine commissions, each led by a Ministry program or directorate. These nine commissions are:

1. Surveillance (General Directorate for Disease Control, DGLM)

2. Port of Entry Surveillance (National Hygiene Program at the Borders, PNHF)

3. Medical care (National Program of Emergencies and Humanitarian Actions, PNUAH, and the National Institute of Biomedical Research, INRB)

4. Logistics

5. Vaccination (Expanded Program on Immunization, PEV, and INRB)

6. Laboratory (INRB)

7. Infection Prevention and Control (Health Directorate of the DGLM)

8. Psychosocial care (National Mental Health Program)

9. Communication and Community Engagement (National Program for Communication and Health Promotion)

World Health Organization High-Level Mission in Butembo

• WHO Director-General Dr Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Dr Matshidiso Moeti concluded their visit to Butembo on Tuesday, 30 April 2019. This high-level visit took place only ten days after the murder of Dr. Richard Mouzoko, a WHO epidemiologist from Cameroon.

• Since the beginning of vaccination on August 8, 2018, 108,175 people have been vaccinated , including 29,182 in Katwa, 23,177 in Beni, 13,355 in Butembo, 6,973 in Mabalako, 4,862 in Mandima, 3,335 in Kalunguta, 3,070 in Goma, 2,729 in Oicha, 2,699 at Komanda, 1,915 at Vuhovi, 1,889 at Masereka, 1,748 at Kyondo, 1,630 at Kayina, 1,487 at Bunia, 1,357 at Karisimbi, 1,313 at Lubero, 1,047 at Musienene, 1,025 at Biena, 772 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

WEEKLY SUMMARY OF EPIDEMIOLOGICAL DATA

Week 17 (April 22-28, 2019)

For the week of April 22-28, 2019, we recorded:

• 1,588 suspected cases investigated and tested in the laboratory

• 126 new confirmed cases :

• The city of Butembo remains the main focus of the epidemic. Together, the two areas of the city, namely Butembo and Katwa, reported half of the new cases (64 cases out of 126, or 50.8%).

• 83 deaths of confirmed cases:

• The town of Butembo is also the main focus of confirmed case fatalities reported last week. The health zones of Butembo and Katwa together reported 53 of the 83 new confirmed case deaths, or 63.9%;

• Of the 83 deaths, 47 were community deaths, or 56.6%, and 36 occurred in an ETC.

Health workers on Ugandan borders are tired of the endless state of Ebola preparedness, an Ebola Simulation exercise carried out early this month has revealed.

The results were disseminated during an international Ebola Virus Disease meeting that begun in Kampala on Monday. The Simulation exercise was carried out in Wakiso and Kasese, which are part of the 22 high Ebola risk districts.

The exercise showed that health workers at different border posts are tired of being on standby. Uganda has been in a state of Ebola preparedness since August 2018 when the disease broke out in North Kivu in DRC.

Dr. Yonas Tegegn Woldermariam, the Country Representative World Health Organisation, says the exercise was an eye opener because it revealed gaps that need to be filled.

Health Minister, Dr. Ruth Aceng attributed the reports of fatigue on the part of health workers to the unfamiliar working environment.

She said there is for financial assistance to make sure that the country bridges the existing gaps. “There’s a need for financial help as the numbers of people suffering of Ebola in DRC increases,” she said.

Uganda’s first Ebola preparedness budget totaled up to Shillings 4 trillion while the next stood at Shillings 3 trillion, according to the health ministry.

The simulation exercise also showed that Uganda needs to re-enforce its border health teams. Aceng says they are planning on hiring more health workers to feel the gaps.

The Health Ministry is set to hire an additional 500 health workers in the 2019/2020 financial year. Similar simulation exercises were also carried out in Tanzania, Sudan, Central Africa Republic, Rwanda, Zambia, South Sudan, Angola and Burundi.

According to WHO, Uganda was not the only country that still falls short in some areas of Ebola preparedness.

Dr. Zabulon York, the WHO Technical Coordinator of Health Emergencies programme who represented the WHO Director General, said results from other countries where the simulation exercise was carried out revealed existing gaps.

He revealed that the countries were rated according to the level of community engagement, infection prevention and control, state of isolation facilities, capacity building and emergency response.

Tropical Cyclone Kenneth passed through the Comoros on 24 April, hitting the northern Ngazidja Island and reportedly causing three deaths, at least 20 injuries and extensive damage to houses across the archipelago. Preliminary estimates indicate that at least 1,000 people were displaced, most of them children.

While assessments are ongoing, initial reports from the Comoros indicate that several villages were flooded due to sea surges and broken dykes, and that power was cut in multiple locations. Roads have reportedly been damaged and cut off by fallen trees, while telephone poles are down in multiple locations.

On the evening of 25 April, Tropical Cyclone Kenneth made landfall between the districts of Macomia and Mocimboa da Praia. Although preliminary information on impact is still incoming, the storm’s cyclonic winds were expected to reach 180 kilometres per hour prior to landfall, according to the Mozambique National Institute for Meteorology (INM).

The Cyclone is forecasted to bring heavy rains, with over 500mm of rainfall expected from 24 to 30 April, and more than 750mm possible in some locations in Cabo Delgado. As the storm comes at the end of the rainy season, river levels are already high, and several rivers are projected to increase beyond the severe alert threshold after landfall, with peak flows most likely to occur on 29 April in the region around Pemba (Mozambique). There is a high risk of flash flooding and landslides.

This is the first time in recorded history that two strong tropical cyclones have hit Mozambique in the same season, with Tropical Cyclone Kenneth following on the heels of Tropical Cyclone Idai, which made landfall on 14 March, leaving more than 600 people dead and an estimated 1.85 million people in need in Mozambique alone.

Tropical Cyclone Kenneth is expected to become only the third satellite-era system to evolve to a moderate tropical storm stage or higher in the area north of the Mozambique Channel, according to Meteo France. The other two systems concerned, Elinah in 1983 and Doloresse in 1996, did not reach the African coast. Tropical Cyclone Kenneth therefore threatens an area where the population is not used to cyclones.

Southern Tanzania and eastern Malawi are also expected to receive rains caused by the weather system. In Tanzania, an increase in cloud formation is already being witnessed, and an increase of rain is expected in Dar es Salaam, Tanga, Pemba, Lindi and Mtwara regions, the south coast of Tanzania and around Lake Victoria.

PREPAREDNESS AND RESPONSE

The Comoros has activated its National Contingency Plan with the establishment of a fixed command post within the General Directorate of Civil Security (DGSC). Ahead of the storm, people living in high risk areas were urged to evacuate to shelters in safe locations. Emergency stocks have been positioned for the health, education, nutrition and WASH sectors and the United Nations has deployed staff to support Government-led assessments.

In Mozambique, the Government and Red Cross volunteers alerted communities in areas where the concern of flooding, erosion and landslides was particularly high and at least 30,000 people were evacuated from areas at highest-risk, according to the National Institute for Disaster Management (INGC). Flights to Pemba have been suspended and schools have been closed in the cyclone’s path. Schools are also being prepared by the government to host people displaced by the storm.

An INGC team, led by the Director-General, has deployed to Pemba, which humanitarian partners are supporting. A joint World Food Programme (WFP)/International Organisation for Migration (IOM) team is pre-positioned in the northern part of the province to support the response. Humanitarian organizations have pre-positioned supplies and have additional teams on stand-by to deploy to the area.

In Tanzania, the Government initially issued a warning saying people in the town of Mtwara should move to higher grounds. However, as the storm path shifted southwards, the warning was stood down, according to media reports.

In Malawi, the Government has issued a statement saying it expects enhanced rainfall throughout the country and in particular along the lakeshore.

Mayor of Butembo (North Kivu) Sylvain Kanyamanda advocates for the reinforcement of the presence of the FARDC and the police to face armed attacks against structures and health workers involved in the Ebola response in that city.

"We do have a problem of insecurity related to the targeting of health sites as well as the stakeholders in the response to Ebola. Today we have multiplied security strategies by what we must adapt to the current operating mode of the attackers. We ask the line authorities to increase the number of elements on the police and FARDC side as we are required to adapt to the new strategies of the attackers so that we can secure the sites and the personnel," pleads Sylvain Kanyamanda.

According to him, this will also ensure the ordinary security of the city of Butembo.

The call comes after the assassination of a Cameroon epidemiologist, a WHO employee, during an attack on a response team in the medical clinics of Graben Catholic University.

April 19, 2019

Comfort Gbainsay is huddled on a bed under a mosquito net at the CB Dunbar Maternity Hospital in Gbarnga, a small city about a 3 hours' drive from Liberia's capital Monrovia. A few days ago, she started feeling weak. She had stomach cramps and was breathing fast. At the hospital, she was diagnosed with stomach ulcers and typhoid fever. The 37-year old is 3 months' pregnant.

The ward is veiled in darkness. With a torch in one hand and a spoon in the other, Gbainsay is eating her dinner from a plastic container. There are not enough funds to run the hospital generators 24 h a day, so electricity is scheduled. This will be her third child, says Gbainsay. Her large eyes look exhausted, her voice is muted. She gave birth to her other two children at CB Dunbar, but back then, she says, she did not have to pay for any of her medication.

CB Dunbar is a government hospital and therefore drugs and services should be free. The National Health and Social Welfare Policy 2011–2021 focuses on an essential package of health services, and the country has set itself the goal of reaching universal health coverage. However, the coverage index for essential health services lies at 34, the target value being 100. Gbainsay has already spent more than LRD3000, or around US$18, on medication during her stay, a third of her monthly income as a teacher.

“The drugs that were here, they gave me; the ones that were not here, they told me to go out and buy”, she says. One of the prescribed medicines is out of stock at all pharmacies in Gbarnga and she had to send her husband to Monrovia to buy it.

“Everything is becoming very difficult because of, I don't know, the economic condition or because of the new president”, she says. “Over the past year, things that we easily used to do just can't be done easily nowadays. If you don't have money, things don't work for you.”

The new president Gbainsay is referring to is ex-footballer George Weah, who was sworn in as head of state in January, 2018. Voters had high expectations and hoped he would rein in corruption, kick-start the economy, alleviate poverty, and rebuild the health system after the Ebola outbreak of 2014–15, which killed 4810 people in Liberia, including almost 180 health workers. When the haemorrhagic fever struck, the health sector was on a slow path to recovery after years of brutal civil war that had ended in 2003.

However the new president has other priorities, as he highlighted in his second annual message in January, of this year. “…I have set my eyes on roads as my administration's path to delivering a better living condition for the Liberian people”, he said and added that good road connectivity will, among other things, “reduce travel times to schools and hospitals”. Health care was otherwise barely touched upon.